Department of Family Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
Ann Fam Med. 2009 Nov-Dec;7(6):555-8. doi: 10.1370/afm.1016.
We wanted to summarize evidence about the diagnostic accuracy of the 5.07/10-g monofilament test in peripheral neuropathy.
We conducted a systematic review of studies in which the accuracy of the 5.07/10-g monofilament was evaluated to detect peripheral neuropathy of any cause using nerve conduction as reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.
We reviewed 173 titles and abstracts of articles to identify 54 potentially eligible studies, of which 3 were finally selected for data synthesis. All studies were limited to patients with diabetes mellitus and showed limitations according to the QUADAS tool. Sensitivity ranged from 41% to 93% and specificity ranged from 68% to 100%. Because of the heterogenous nature of the studies, a meta-analysis could not be accomplished.
Despite the frequent use of monofilament testing, little can be said about the test accuracy for detecting neuropathy in feet without visible ulcers. Optimal test application and defining a threshold should have priority in evaluating monofilament testing, as this test is advocated in many clinical guidelines. Accordingly, we do not recommend the sole use of monofilament testing to diagnose peripheral neuropathy.
我们旨在总结 5.07/10-g 单丝测试在周围神经病变诊断准确性方面的证据。
我们对评估 5.07/10-g 单丝用于检测任何原因引起的周围神经病变的准确性的研究进行了系统回顾，以神经传导为参考标准。使用诊断准确性研究质量评估工具（QUADAS）评估方法学质量。
我们查阅了 173 篇文章的标题和摘要，以确定 54 篇可能符合条件的研究，其中 3 篇最终被选入数据综合分析。所有研究均局限于糖尿病患者，根据 QUADAS 工具显示存在局限性。敏感性范围为 41%至 93%，特异性范围为 68%至 100%。由于研究的异质性，无法进行荟萃分析。
尽管单丝测试经常被使用，但对于没有可见溃疡的足部神经病变的检测，几乎无法说明该测试的准确性。在评估单丝测试时，应优先考虑最佳测试应用和定义阈值，因为该测试在许多临床指南中被推荐。因此，我们不建议单独使用单丝测试来诊断周围神经病变。
